June 28-29, 2005 IHE - Effective Integration of the Enterprise and the Health System 1 Integrating...

June 28-29, 2005 IHE - Effective Integration of the Enterprise and the Health System

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Integrating the Healthcare EnterpriseIntegrating the Healthcare Enterprise

Presentation of Grouped Procedures

Charles Parisot, GE HealthcareIHE IT Radiology Planning and Technical Committees


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AgendaAgenda

Scheduled Workflow: Refresher on critical workflow concepts

Scheduled Workflow:Refresher on well identified workflow cases

Presentation of Grouped Procedures:Taking the Group Case a step further

What should I do as an implementer ?Taking advantage of the new Appendix A


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Store ImagesStore Images

Storage CommitmentStorage CommitmentStorageStorage

CommitmentCommitment

List of ImagesList of Images

PACS &PACS &ArchiveArchive

RISRIS

ModalityModalityPerformedPerformedProcedure Procedure StepStep

Performed Step:Performed Step:

Status = CompletedStatus = CompletedPerformed CT HeadPerformed CT HeadPat Name/ID, Dose, Pat Name/ID, Dose,

Accession #, Study UIDAccession #, Study UIDComplete List of ImagesComplete List of Images

A Closed LoopA Closed Loop•Update IS SchedulingUpdate IS Scheduling

•Match Procedure with OrderMatch Procedure with Order•Support Billing Based on MPPSSupport Billing Based on MPPS

•Avoid Reading incomplete ProceduresAvoid Reading incomplete Procedures

IHE Scheduled WorkflowIHE Scheduled Workflow

Modality WorklistModality Worklist

WorklistWorklist

Procedure ScheduledProcedure Scheduled

Patient Registration/UpdatePatient Registration/UpdateOrder ManagementOrder Management


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IHE Workflow ConceptsIHE Workflow Concepts

Procedure Steps : The smallest unit of work in the workflow:

SCHEDULED PROCEDURE STEP: ‘A unit of work to do’

PERFORMED PROCEDURE STEP: ‘A unit of work done’

IHE identifies four fundamental workflow information units :IHE identifies four fundamental workflow information units :

REQUESTED PROCEDURE : : A Unit of Reporting WorkA Unit of Reporting Workwithwith associated codified, billable acts associated codified, billable acts

ORDER : A request for radiologic A request for radiologic

serviceservice


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IHE Workflow is User DrivenIHE Workflow is User Driven

Information Unit has its Prime User

OORDER:RDER:A request for A request for imagingimaging service service

(Accession Number)(Accession Number)

REQUESTED PROCEDUREREQUESTED PROCEDURE : : Units of work resulting in one Units of work resulting in one ReportReport

with with associated codified, billable actsassociated codified, billable acts(Requested Procedure ID)(Requested Procedure ID)

PROCEDURE STEPPROCEDURE STEP : :The smallest unit of workThe smallest unit of work

in the workflowin the workflow(modality worklist entry)(modality worklist entry)

CLINICIANCLINICIANOR REFERING DOC:OR REFERING DOC:

The Imaging Dept CustomerThe Imaging Dept Customer

RADIOLOGISTRADIOLOGIST : : In Charge of producingIn Charge of producing

thethe ReportReport

TECHNOLOGISTTECHNOLOGIST(and RADIOLOGIST)(and RADIOLOGIST)

In charge of acquiring In charge of acquiring images, etc.images, etc.


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Normal WorkflowNormal WorkflowTypical workflow: One Order – One Procedure – One Report

ORDERA request for RadiologicService

RequestedProcedure

Radiology Department

One or more series of images

ReportSet of

Codifiable,Billable,

ActsAcquisition Modality


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AcquisitionModality

AcquisitionModality

Multiple Modality StepsMultiple Modality Steps



Set of Codifiable,

Billable, ActsOne or more series of images

PerformedProcedure

Step P1

ScheduledProcedure

Step B

RequestedProcedure

1

ScheduledProcedure

Step A

Report


PerformedProcedure

Step P2

DICOMModality Worklist



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What is the Clinical Problem?

MultisliceMultislice CT and high speed MR generate HUGE CT and high speed MR generate HUGE quantities of images quicklyquantities of images quickly 3000+ Images3000+ Images

No need to load all when only a subset neededNo need to load all when only a subset needed

Multiple orders and / or requested procedures Multiple orders and / or requested procedures done in one acquisitiondone in one acquisition

Entire exam may not read by one radiologistEntire exam may not read by one radiologist

Clinicians often not interested in entire examClinicians often not interested in entire exam

Can’t track status of each requested procedureCan’t track status of each requested procedureComments and Suggestions

Gary Wendt, MDGary Wendt, MD

University of Wisconsin University of Wisconsin -- MadisonMadison

gjwendtgjwendt@@facstafffacstaff..wiscwisc..eduedu

www.radiology.www.radiology.wiscwisc..eduedu


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The Group Case ApproachThe Group Case Approach

ORDERA request for RadiologicServiceCT Chest & Abdomen


Acquisition Modality

RequestedProcedureCT Chest

RequestedProcedureCTAbdomen

Report

CT Chest

Set of Codifiable,

Billable, Acts

Report

CT Abdo

Set of Codifiable,

Billable, Acts


One OrderOne Order – – Two ProceduresTwo Procedures – – One AcquisitionOne Acquisition - - Two ReportsTwo ReportsStepStep


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Group CaseGroup Case



ReportSet of

Codifiable,Billable, Acts

AcquisitionModality

ReportSet of

Codifiable,Billable, Acts

RequestedProcedure

2ScheduledProcedure

Step B

RequestedProcedure

1ScheduledProcedure

Step A


PerformedProcedure

Step P1



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Is Grouping of Procedures a common need ?Is Grouping of Procedures a common need ?

CT Chest/Abdomen/Pelvis

Neuroradiology: CT Neck & CT Chest

MR Imaging of different sections of the spine

MRI and MRA of vessels acquired together

MRI of the head and neck with specialized coils

Direct radiography (DR) in a trauma patient: AP images, then move the patient once to acquire a set of orthogonal images, and then regroup by body part

Sonographic evaluation of the kidneys and of the abdomen

CT of the pelvis with CT angiographic runoff

Angiographic studies of multiple vessels mixed with therapeutic interventions on selected segments.


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Why is the Grouping of Procedures a significant Why is the Grouping of Procedures a significant need ?need ?

Maintain the link back to each one of the grouped procedures without breaking the acquisition apart.

Ensure that each image subset related to a requested procedure is identified and ready to be presented. This is key for quick display of new and prior studies.

In the film world, images are manually sorted. In the film-less world, images should be sorted automatically when displayed

• Optimize patient comfortOptimize patient comfort

• Optimize time of image acquisition.Optimize time of image acquisition.

But, there is the need to:But, there is the need to:


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Grouping of Procedures in IHEGrouping of Procedures in IHE

Group Case support is required by the IHE Scheduled Workflow Integration Profile:

• On Image Managers (PACS)• On Order Fillers (RIS).

Group Case support is optional on Modalities.

PGP requires support of the “Group Case Option” on Modalities.


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PGP Integration ProfilePGP Integration Profilebuilds upon SWF and CPIbuilds upon SWF and CPI

ConsistentPresentation of

Images

Softcopy grayscale and

presentation state

Scheduled Workflow

Admit, order, schedule, acquire images, notify of

completed steps+

Presentation of

Grouped Procedures

Presentation of Subsets of a Single Acquisition

Required for


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MODALITY

IHE – Presentation of Grouped ProceduresIHE – Presentation of Grouped Procedures

Requested Requested Procedure:Procedure:

CHESTCHEST

Report:Report:CHESTCHEST

Requested Requested Procedure:Procedure:ABDOMENABDOMEN

Report:Report:ABDOMENABDOMEN

Performs a single acquisition

Operatorgroups

2 procedures

Chest Chest ViewView

Abdomen Abdomen ViewView

RIS / PACS


Abdomen Abdomen ViewViewScheduled

ProcedureStep Chest Scheduled

ProcedureStep Abdo


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Presentation of Grouped ProceduresPresentation of Grouped Procedures

Improves workflow, overall efficiency of care and reduces costs of providing services:

Lowers barriers to migration to digital radiology practice

Optimizes use of newer & faster acquisition devices

Improves clarity and access to Radiology results

Simplifies and facilitates billing of grouped procedures

Enhances softcopy interpretation throughput


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What will PGP do for me?

Multiple orders and /or requested procedures done Multiple orders and /or requested procedures done in one acquisitionin one acquisition

Entire exam may not be read by one radiologistEntire exam may not be read by one radiologist

Clinicians often not interested in entire examClinicians often not interested in entire exam

Enable tracking status of each requested procedureEnable tracking status of each requested procedure

Reduce impact of huge datasets on clinical and Reduce impact of huge datasets on clinical and system infrastructuresystem infrastructure

Comments and Suggestions

Gary Wendt, MDGary Wendt, MD

University of Wisconsin University of Wisconsin -- MadisonMadison

gjwendtgjwendt@@facstafffacstaff..wiscwisc..eduedu

www.radiology.www.radiology.wiscwisc..eduedu


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IHE PGP - Implementation Example IHE PGP - Implementation Example Image Display ConstraintsImage Display Constraints

MODALITY

Requested Requested Procedure:Procedure:

CHESTCHEST

Report:Report:CHESTCHEST

Requested Requested Procedure:Procedure:ABDOMENABDOMEN

Report:Report:ABDOMENABDOMEN

Performs a single acquisition

Operatorgroups

2 procedures



Order Filler



ScheduledProcedureStep Chest

ScheduledProcedureStep Abdo

Image Mgr

(Incl. Display)

PGP Actors



ImageDisplay

CPI only Actor

Image Displayhas no access to fullRequested Procedure

Information


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Implementing PGP made easy !Implementing PGP made easy !

Feedback from early implementors has resulted in significant improvement for the Technical Framework:

•Appendix A has been entirely restructuredAppendix A has been entirely restructured to provide a thorough and unambiguous specifications of all SWF+PGP workflow cases.

•The NewThe New Appendix A defines precisely every Appendix A defines precisely every details for information mappingsdetails for information mappings in modalities between MWL, Images/Presentation States, Modality PPS. This is critical information for PACS and RIS implementations of SWF and PGP.

20 IHE - Effective Integration of the Enterprise and the Health System

June 28-29, 2005

Technical Frameworks:Technical Frameworks: www.ihe.net/TF

Connectathon results:Connectathon results: www.ihe.net/CNCT

Vendors Integration Statements:Vendors Integration Statements: www.ihe.net/IS

Sponsors Web sites:Sponsors Web sites: www.ihe.net/SPR

Chapters World-wide:Chapters World-wide: www.ihe.net/WORLD

Questions?

Questions?W W W . . N E TW W W . . N E T


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W W W . I H E . N E TW W W . I H E . N E T

Providers and Vendors

Working Together to Deliver

Interoperable Health Information Systems

in the Enterprise

and Across Care Settings

June 28-29, 2005 IHE - Effective Integration of the Enterprise and the Health System 1 Integrating...

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Transcript of June 28-29, 2005 IHE - Effective Integration of the Enterprise and the Health System 1 Integrating...